World class health care innovation starts in Alaska

In the areas of health and wellbeing, Alaska is frequently last in many indicators that are not a source of pride for our state. But in the U-Med district of Anchorage, a revolution is taking place that holds the promise to make Alaska first in innovating health care. It is called Nuka.

In many ways, it makes sense that Alaska is ground zero for health care innovation. When it comes to health care costs, we are the top of the top. Alaska spends the most in a country with the highest health care costs in the world. Yet the performance of our health care system does not match its cost. Alaska is one of the best states to be born in, but our babies are less likely to survive and grow into healthy adults than in any other state.

We need a new health care paradigm, which is exactly what Southcentral Foundation has been constructing since it assumed responsibility in 1998 for the health care of the region's Indian Health Service beneficiaries. Instead of simply taking over what many saw as a failed system, SCF used the opportunity to redesign the system totally. The result is SCF's "Nuka System of Care," the whole health care system created, managed, and owned by Alaska Native people to achieve physical, mental, emotional and spiritual wellness.

The Nuka System puts the client-provider relationship at the forefront. Instead of being the objects to which medical services were provided, beneficiaries became the essential partner, metaphorically the managing director, of a series of processes focused on attaining wellness rather than just treating illness. Patients have been transformed into customer-owners.

The benefits of this approach, which is also called patient-centered medical home, is apparent to me at a very personal level. My husband has received his health care from the Native medical system since he was born. After we were married, in the late 1980s, when he needed to see a doctor, he would get up very early in the morning to go to the old Native hospital on Third Avenue in downtown Anchorage. Once there, he would sit in the crowded waiting room for hours, sometimes all day. Some days he would never see a doctor, and come back home. Today he is guaranteed a same day appointment with his regular doctor. And the quality of care is as good or better than any available in town. Today he has options, but chooses to get his health care from SCF.

The elements of the Nuka System practiced at SCF for more than a decade (life-long relationships between the provider and client, and shared responsibility for wellness) have become state-of-the-art best practices that improve health outcomes through better coordination of services; integrated care across a range of health needs; consumer empowerment as an active partner in care; and better orientation to cultural backgrounds. Perhaps the most important outcome of the Nuka System is a reduction in the discrepancy between the quality of health care and the cost of that care.

Nuka was the basis for SCF's 2011 Malcolm Baldrige National Quality Award. In his announcement of the award, the U.S. Secretary of Commerce cited "innovative practices, an unwavering commitment to excellence, dynamic management and proven results."

Recognition of Nuka has brought increased numbers of people from Alaska, the United States and the world to the U-Med district wanting a firsthand look at the Nuka System. SCF has responded to the intense demand by organizing annual conferences, providing consulting services, and assisting other tribal health systems in adopting the Nuka System.

In June, Rasmuson Foundation, with a $3 million grant, joined SCF, the Robert Wood Johnson Foundation, and the Gordon and Betty Moore Foundation as an investor in the creation of the Nuka Institute. The Nuka Institute will provide leadership, training and technical assistance to help health care systems across the state and world learn about and adopt the Nuka model. The creation of the institute as a separate entity means that SCF can respond to the market demands for training without diminishing its core local health services.

High-cost, inefficient healthcare care affects not only those who need and pay for services, but each of us through the lost productivity and unfulfilled promises of lives diminished by poor health outcomes. Because a significant portion of Alaska's health care bill is paid by public sector programs, making care more affordable, proactive and efficient is prudent public policy. For those with a focus on continued economic stability in our state, access to high quality, affordable care makes Alaska a more desirable place to live and work, and improves our collective quality of life.

At Rasmuson Foundation, we applaud SCF CEO Katherine Gottlieb, recipient of the MacArthur "Genius Grant," and Dr. Doug Eby, former member of the Rasmuson Board of Directors, and many others at SCF in creating and implementing the Nuka System. The Nuka Institute will continue to reinforce SCF's -- and Alaska's -- position as a national and international leader in health care innovation.

Diane Kaplan is president of Rasmuson Foundation.

The views expressed here are the writer's own and are not necessarily endorsed by Alaska Dispatch News, which welcomes a broad range of viewpoints. To submit a piece for consideration, email commentary(at)alaskadispatch.com.